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The purpose of this book is to help athletes deal with their injuries. I will assume the role of the hypothetical basketball player who encounters knee injury during one of his matches. Through this hypothetical player I will explain order to play once again without the fear of being injured again.

The first chapter named “A small introduction to the USA college athletics” is reserved for readers who aren’t familiar with college sports or for those who would like to learn more about the college sports phenomenon. I feel that the better understanding of the college sports phenomenon will help you understand the essence of this book, which is the problem of dealing with injury.

A small introduction to USA college athletics

The reason why I chose to write about USA college sports exclusively is actually very simple: the USA college athletics system is by far the most competitive, the biggest and the strongest college athletics system. If one were to compare the USA’s NCAA (the National Collegiate Athletic Association) and the United Kingdom’s BUCS (the British Universities and Colleges Sport), one would immediately, without any deeper research whatsoever, notice the obvious differences in the size, quality, competitiveness and the seriousness of both systems. Many other countries have their own college athletics systems (such as China, Japan, South America…), but they are nowhere near the USA’s college athletics. Why is that the case?

Well, besides the previously mentioned NCAA, the USA’s college system also includes organizations such as NAIA (the National Association of Intercollegiate Athletics) and the NJCAA (National Junior College Athletic Organization). Moreover, due the complexity and the uniqueness of the USA’s college system, there are other organizations that specialize only in one sport, such as National Collegiate Boxing Organization, or USA Rugby. All these above mentioned organizations are the tier-one systems because of popularity, importance and competitive nature of these systems. They are also highly selective and only the best athletes in their desired sport will qualify and be able to participate in the competition. There are also the tier-two systems which are more open to the wider number of students due to the nature of the system itself, which is less competitive and more recreational than the tier-one system. The intention of the USA’s college athletics is very similar to any other professional and non-professional sports organization in the world: it promotes equality, sportsmanship, fair-play, competitiveness, nondiscrimination…

College athletics is not only important for American students and their universities, but for the American society. Following the parole of the “American Dream,” each student has the opportunity to compete and to participate in the intercollegiate activities and competitions. To demonstrate the importance of athletes in the USA’s academic society, the hardest and the elite athletes are firstly referred to as athletes, not students. So, if you are an elite athlete in one of the universities, your primary role is to be an athlete who represents the colors of the university, and your secondary role is being a student. American universities promote not only their successful scientist or lawyers, but they also take pride in their sports achievements; it is part of the American culture. There is also the economic side to this story because college athletics is almost run like a professional league:, promoting rivalries, collecting sponsors and donations, signing broadcast contracts with numerous media stations and selling tickets and merchandise. Moreover, American universities that participate in college athletic competitions hire coaches, physicians, referees… American college athletics also attract athletic students from other countries, providing scholarship not only for the American students, but also for other non-American students.

Why is there so much time, effort and attention put into American college athletics? Well, the USA’s college athletics are directly connected to the professional sports organizations such as NBA or NFL. Unlike other countries, American professional clubs select the best college athletes and provide them with professional contracts. In other countries, clubs usually have their own academies where they train and develop players from youth to the professional level and during that process the clubs select the best players and provide them with professional contracts. In USA however, the process of selection is already done on university level, meaning that the professional clubs will harvest the already prepared crop through scouting and drafting programs. This is also the reason why USA’s college athletics systems are so highly organized, providing excellent training facilities, well-paid coaches (some of them are literally millionaires!), referees. For the last few years there is also a huge debate whether a professional pay should be paid to college athletes, but I will return to this later.

So, if you were a college athlete, wouldn’t you be under a lot of pressure? Vast organization, high competition and pyramidal selection, high dreams and low chances of success? Pressured from the parents, coaches, players, public, and on top of everything else, you still have a duty to other professors, you have classes to attend and homework to do. Do you still think that being an athlete is easy and a privilege? Think again…

Living the “dream” before the injury

Being an athlete is a way of life, a hard life, a samurai-like life. Playing a sport is a matter of choice, not a matter of predetermined path. Sure, a person can be a talented basketball or a football player, but it is the hard work and determination that shape that uncut diamond into a beautiful jewel. Remember, I am talking about being a student and an athlete; being one or the other is hard by itself.

Firstly, I’m going to focus on time-period before the season even starts. This includes long and stressful days when our hypothetical player has to wake up very early because he has classes to attend (skipping classes is not a desirable option). After he is done with all his classes, he probably goes to gym or a practice field and does the things he has to do: running, push-ups, sit-ups, he practices passing, offense, defense, short, mid and long-range shots; you name it!

Despite not being paid like a professional football or a basketball player, he definitely has to behave like a professional player, meaning that his trainings usually last between 2-3 hours, depending on the intensity of the training itself. Sometimes the practice will be moved to 6 a.m., sometimes they will be canceled, but that doesn’t mean that our player won’t practice that day, because he has to keep his condition up, his stamina mustn’t deteriorate and his muscles mustn’t rest, even for a day!

When the training is finished, our player has time to take a shower, grab something to eat and maybe, maybe time for a nap. Why? Well, he still has homework to do! Another important factor of this samurai-like life is nutrition. Special training regimes often include special diet regimes. Some players will need to get a few extra pounds, some will need to lose them. These cases are indeed situational and optional, but universal diet of every college athlete is avoiding junk food regardless of whether it is a preseason, season or a postseason time because he or she will eventually have to lose those unwanted calories; not being able to eat an ice-cream is definitely not a privilege!

One would probably think that professors will cut him some slacks because he is an athlete. One would assume that the coaches and the athletic trainers will do the same because he is also a student, but this is rarely the case. Often times he will have to leave the class earlier or even skip it because of the practice, but professors will not greet this type of behavior. Likewise, if he skips his practice or arrives late at them, he needs to be prepare for some “special” treatment from coach.

But all is not that black. When the season finally arrives, coach gives to our player the best possible gift… a place on his team. Now that he is in first team, nothing really changes in terms of things being easier for him. On the contrary, he now has to work harder to keep his position. He also has to deliver numbers and performance during the matches, because stats rarely don’t lie. If he doesn’t score, assist, block, rebound or steal, he shouldn’t expect to stay in the first team for too long. This adds more pressure in already pressured life and because of that pressure his life gets even harder, because that pressure can affect his grades, relationships etc. But, if he really loves the game he is playing (and let’s assume that our hypothetical player does), every obstacle is just another obstacle to overcome because he knows that he will become stronger when he overcomes them.

But why would someone go through this? Well, when the game does start, nothing else matters. This is his time to shine and this is the place where he can prove that he deserves to be a part of the team, that he practiced hard, that he listened to coach’s suggestions, that he is improving each and every day, that he is prepared for every match, that he is involved in team events and team-talks, that he does pay attention to details when he watches the replays of his next opponents.

Thus sport plays a huge role in athlete’s life because being an athlete is who you are. When athlete puts enough effort and time into his sport, that sport becomes fundamental aspect of his identity and personality. Athletes grow and develop through sport, because they learn about discipline, teamwork, they get better and stronger through sweat and blood (literally!). Playing favorite sport is a safe haven for athletes, it is a coping mechanism, and a way to deal with stress and a place where he can express himself like a painter expresses himself through his paintings.

There are no words that can describe the feeling of playing against high level opponent, the feeling of competition, the crowd cheering and coach yelling with instructions in his hand; it’s a warzone. He watches your teammates tackling, passing, team is performing tactical actions that they’ve practiced more than a hundred times and our player finally understands why did the coach insist on perfect execution because on high level, you only have one chance to do it right, otherwise the opponent will figure him out and the action will backfire.

There were also rumors that the scouts are in the crowd, but he has no time to think about that because if he isn’t concentrated for just one second, he will step out of the defense formation and reduce his team’s chances to defend. The court is also a place where he, being an individual player, can prove and showcase his skills and moves that he’d practiced for so long, every day, every month, driven to perfection.

Eventually, the chance presents itself to shine, he is holding the ball, he is dribbling, he is going for a layup to extend the team’s lead, the opponent is late for block and tackles our player in mid-air. He falls on the floor, the crowd is cheering because he earned free throws, but he is unable to stand up and take the shots. The doctors carried him out of the court while the crowd was giving him a huge applause.

Coping with injury

When it comes to injuries, every athlete is aware of the possibility that he or she can succumb to injury. It needs to be understood that athletes train in continuous state of pain and fatigue because of the intensity of the sport’s program. Being under constant emotional pressure also doesn’t help, because there is no real distinction between mind and the body; one reflects the other, meaning that the emotional problems will reflect on the physical body and the physical injuries will affect emotional state of the player. Dealing with constant pain and exhaustion is problematic, but dealing with severe and serious injuries is the athlete’s worst nightmare, especially for those who reach the Division I NCAA levels, moreover if they made it to first team. The cultural encouragement to endure pressure also doesn’t help, because players will often neglect the warning signs that their bodies send to them. Thus the players ignore the pain because of their goals and dreams and the effort that they have put into the sport they love.

Dealing with injury is never easy because your life turns upside down in just one brief moment. It gets even worse when the doctors tell you that your injury will require surgery, leaving you out of the practice courts and matches for months or even for the whole season. Being injured could be divided into two categories: inside and outside consequences.

Outside consequences are those that affect everyone within the player’s societal circle, primarily his teammates, coaches and physicians. Coaches and teammates often end up being under a lot of pressure when their key players are injured because each player, regardless of the universal team tactics, formations and playstyles, has a unique playstyle and contributes to the team composition and chemistry in his own way. Substitution will often fail to fulfill that role regardless of the substitution’s quality. Another aspect of these outside consequences is the support that the injured player receives from his teammates, coach, trainers, doctors, friends and family. This aspect is connected to the second category, which are the inside consequences.

Inside consequences are those that are unique and vary from player to player. The biggest problem of this category is the loss of identity because if our player isn’t playing his sport, then who is he? I would like to point out that human being is more than he thinks he is and more than he does, but it is simply hard to accept that you aren’t able to do the things you have been doing for years. There are also fear of the unknown and the anxiety because there is no guarantee that the player will be able to play on the level he played before and that there is no predictable epilogue to his situation; surgery can go wrong, recovery can take longer, the fear of being injured again etc.

When we combine this two categories, we get a lot of negative psychological states. One of the most obvious and common result is the mayor stress. What is stress? Stress is the experience when individual is faced with more demands than he can cope with (basically, too much stuff is going on and you are feeling that things are getting out of control!). Note that being stressful before the exam and being stressful because of injury is a different type of stress because injury-related stress is a long-term stress that can negatively affect the future rehabilitation process, meaning that it can prolong the rehabilitation. This long-term stress can likewise have negative impact on player’s grades, relationships, his goals and dreams. There is also the relation between the severity of injury and mood states. Obviously, minor injuries are easier to deal with and thus easier to overcome.

Unfortunately, our hypothetical player suffers from severe meniscus injury and will need to undergo a knee surgery; he is out for the rest of the season. He is shocked and under a lot of stress. He needs to adjust to his new situation, because the sooner the player accepts what happened to him, the sooner he will be playing the sport he loves. As I’ve mentioned before, support from friends, family and teammates is always welcomed, but not guaranteed. Some players don’t have a family, or friends, but they do have teammates. But these are all the things that our player cannot influence, meaning that he cannot decide whether someone will support him or not.

Being sad, depressed or anxious is perfectly natural response to this hypothetical situation and I think that it is very important to say that! No, you don’t need to “man up” (manning up can actually get you injured), being sad or depressed is not a sign of weakness, but a natural response to the situation. Think about it; our player just wants his old life back. Those painful days packed with activities, early alarms and late studying now appear as a joke, but human beings are like that; we usually appreciate things when we lose them. Injuries also affect physiological processes like sleep, and appetite; players need to understand that not eating and sleeping can only prolong their injuries. Seeking help from a psychiatrists or priest is also an option because conversation with professional or a local priest (for religious athletes) can help a lot. And no, seeking help is not a sign of weakness, but sign of strength and matureness because acknowledging and recognizing your limitations in dealing with given situation is already a sign of progress.

But here I would propose a different and unconventional approach to injury, and that is giving up the control. Let me demystify the “giving up the control” term. You can Google up the “dealing with injuries” and find a lot of helpful articles and advices on how to deal with injuries. But I propose that you don’t do it, that you find your own way of dealing with undesirable and unpredicted situations because it will benefit you in the future. It has already been proven that there are things you cannot control because you are injured and you certainly didn’t want that to happen. Furthermore, trying to control things can often backfire, and by control I mean THINKING about things that COULD happen. You cannot speed up the healing process by not eating or not sleeping. Moreover, worrying about the surgery is absurd, since you being worried won’t change the outcome of surgery. In fact, it can only worsen things. So how does our hypothetical player prepare for his knee surgery?

Coping with pre-surgery

Before writing this book I did a lot of research and read a lot of academic articles that dealt with this issue and I found, in my opinion, a lot of complicated and unnecessary advices, from checking up who your anesthesiologist is to how good are your nurses. Sure, these things won’t hurt, but they are just another concern, another reason to check up and more reasons to worry about. I repeat: give up the control!

Here is the essential problem with surgery: your goals and dreams are tied to it, and yet you have no control over it. This situation is so simple to understand and yet so difficult to be in. Sure, there are easier surgeries with less risk and harder surgeries with high risk, but it is a surgery nonetheless. In this chapter I will talk about pre-surgery and how to prepare for it. Furthermore, I will focus on the psychological aspect more than a physical aspect, because doctors and surgeons often give clear instructions of what type of activities or food should be avoided.

First and foremost, dealing with pre-surgery is unexplored and new experience for most people. Whether you have experienced pre-surgery period or not, you can assume that the fear plays the most important factor in this chapter. There are good and bad fears. Can a fear be a good thing? Some would disagree, but I believe that being afraid before surgery is a natural response to the situation, especially if you are afraid that you won’t be able to do the things as you did before. Being afraid is also the sign that you are aware and prepared for the dangerous of surgery. This pre-operation good fear has an impact on post-operational reaction, meaning that our player will have better reaction to negative outcome or positive outcome of the surgery, unlike the patients who aren’t afraid of surgery (because they are usually in denial of any potential danger) or patients who are highly afraid, even neurotic (this would be the bad fear).

Patient who is “badly” afraid will often negatively respond to the operation regardless of the outcome, especially if the outcome is bad. They can blame the medical staff or the whole hospital for the outcome. Furthermore, they might believe that their extreme fear was justified which can encourage such behavior in the future, and I don’t want that our hypothetical player becomes neurotic person; I want him to be a basketball player!

Anxiety also plays a huge role in pre-operation time. Let me describe to you anxiety in the simplest terms possible: it is a constant oscillation between “I will be alright” and “I won’t be alright”. These oscillations happen because of two factors: time and no control, time being the waiting period and control being the lack of it.

Let us assume that our player has the world’s best surgeon at his disposal and that he has done every possible physical preparation for the surgery: he decorated his room, ate properly, he doesn’t smoke and drinks only water, has the best medical staff on this planet, his family, friends and teammates are always supporting him. Do you think that our player isn’t afraid or anxious? Of course he is afraid and anxious. Why? Because he has absolutely no control outside the control that is given to him. Sure he can turn his hospital room into his bedroom and he can afford the best surgeon in the world, but he will be out of it and there is no way that he can affect the outcome.

So no, if you are facing a surgery in the future, I’m not telling you that you shouldn’t worry, that you shouldn’t be afraid or anxious, I’m telling you that it is all natural. My personal advice for our hypothetical player is Amor fati: accepting the outcome no matter what it is. No matter what the outcome is, you will keep fighting and you will not give up, as long as you are alive, you will not give up. Remember, being an athlete is a samurai-like life and that means being a fighter to the end!

Recovery process

Coping with post-surgery (rebounding!)

The surgery went well and our player is in recovery process. The worst is over, because now our player at least has control over the recovery process. But despite being in position of control, the duration of recovery process is hard to predict because even the best doctors, surgeons and physicians are unable to predict how the individual will react to post-operation, recovery and rehabbing process. The psychological well-being plays a huge role in this process.

Despite the successful surgery our player is still afraid; he fears that he will not be able to play on the level he played before or that he won’t be able to play at all! To tell someone who loves sport and literally lives it (because everything, from diet to everyday conversation, is about sport) that he won’t be able to play it again is heartbreaking. Rehabilitation process is usually a long and stressful period for injured player. Our player got his instructions from the surgeons and doctors: he will have to wait another month before he can hit the gym and start with light exercises. Meanwhile he is attending his classes and cheering and supporting his team. This is hard for any player, amateur or professional, to sit on the bench and not being able to help your team. He is also constantly bombarded by questions. Some of those questions are normal, questions like “How do you feel”, “How is the recovery process going” or “When will you be playing again?” Answering this questions can be quite difficult. Our player is often annoyed by this questions because often times he doesn’t know the answer to those questions. He must remain patient and have faith in himself.

Up until this point I didn’t really talk about pain. The reason for that is quite simple: pain is easy to understand. When you are injured and in pain, you understand that you are in pain because you were injured (quite simple logic). After the surgery our player is in pain, but that pain is not intense as it was before the surgery. Here I’m talking about the annoying pain, the kind of pain that isn’t intense enough for you to lie in bad but is intense enough for you to be in a constant state of awareness. Since our player suffered from meniscus injury and surgery, he is always aware of the position of his leg. He has to sit properly, he has to avoid crowded spaces, and he uses crutches. Try to imagine this situation: a month ago you were a hot prospect athlete with high hopes and dreams and now you can’t even walk without the crutches, you can’t move your leg in certain direction because it hurts like hell! This is a very stressful time for our player.

The mind plays a huge role in the recovery process. I believe (and many psychologists and philosophers would agree) that the pain is usually attached to the emotion that was felt during the pain process (basically, pain is often psychological). Now this does not mean that when you break your leg that the pain is psychological, it simply means that you focusing on the pain will increase the intensity of the pain and can even prolong the recovery time.

Here is what I propose: get angry! Yes, you heard me. Instead of being sad, depressed or anxious about your injury, you get angry. Why? Because you should embrace whatever life throws at you (Amor fati) and you will give your best to play the sport you love. Thus our player defies the rules, the predictions and common knowledge and logic. If there is little to no chance that you won’t be able to play again, you test it. There were numerous cases where professional athletes were told that they won’t be able to play the sport again, they were advised to quit, but they tried anyway. After all, it is you, your body and no one knows the state of your being better than you.

Thus our player, even inactive, is taking an active role in his post-surgery recovery process. He keeps his positive mentality during the rainy days; he is his own sunlight. He is imagining in his head that the meniscus is healing, he is feeling it. Yes, our player isn’t cutting any corners and he is following his doctor’s orders but often times this isn’t enough. People aren’t really aware who they really are. Think about this for a second: your heart is pumping blood every day, every hour, minute and second, your enzymes are breaking down fats and proteins and your mitochondrion are producing pure energy and you are doing it. You are your heart, your red blood cells, and your lungs and even though you can’t verbally explain how you are doing all this, know that you are doing it. Now tell me, will you allow that your injury puts you down, no matter how severe it is?